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2180 Satellite Boulevard, Suite 400-25
Duluth, GA 30097
Website: www.bdmarket.com
Tel: 678-835-9002
Toll Free: 800-454-0629
Fax: 678-815-1524
Instructions
The following pages are in a form fill format. You can enter the information requested and print the documents for
faxing or save it to your computer to use for email. Which ever you should prefer. Should you choose to, you can
just print this document and hand write the information requested as well. Please be detailed in your responses as
the more we know about you and your needs, the better we can match you with a potential buyer or seller.
•
Where text is required to be entered, you can simply click in the appropriate box and type your response.
•
If it is a Box that needs to be checked, simply click the appropriate box and hit the “X” key on your
keyboard.
BROKER DEALER MARKET, INC.
2180 Satellite Boulevard, Suite 400-25
Duluth, GA 30097
Website: www.bdmarket.com
Tel: 678-835-9002 • Toll Free: 800-454-0629 • Fax: 678-815-1524
REGISTERED INVESTMENT ADVISOR (RIA) FIRM PROFILE, (PLEASE PRINT OR TYPE)
Name of firm:
Address:
City:
State:
Zip:
Name of
owner/representative:
Telephone:
Fax:
Email address:
Corporation details
State:
Date:
Type:
Number of owners / shareholders?
Number of authorized shares?
How many branch offices?
Business details
1.
2.
Investment adviser
SEC #
Date:
Broker Dealer
CRD #
Date:
Do you have a Net Capital requirement by your state? Yes
Are you compliant? Yes
3.
No
No
Are you registered with a foreign financial regulatory authority? Yes
No
If yes, please specify:
4.
Approximately how many employees?
How many are licensed Financial Planners
How many of these perform investment advisory (including research)?
How many of these employees are registered representatives?
5.
Clearing arrangement:
Select One
6.
Number of client accounts:
7.
Total assets under management:
8.
What percent is fee based?
9.
What types of clients do you have? Please indicate below the percentage for each.
10.
$
%
Individuals (other than high net worth individuals)
%
High net worth individuals
%
Banking or thrift institutions
%
Investment companies (including mutual funds)
%
Pension and profit sharing plans
%
Other pooled investments (i.e., Hedgefunds)
%
Charitable organizations
%
Corporations or other businesses not already listed
%
State or municipal government
%
Other:
%
Please indicate the different types(s) of advisory services you provide?
Financial Planning
Pension Consulting
Publication of Periodicals or Newsletters
Portfolio - For Individuals or Small Businesses
Portfolio - For Businesses or Institutional Clients (Not Including Investment Companies)
Portfolio - For Investment Companies
Security Ratings or Pricing Services
Market Timing
Other (Please Specify):
11.
Please describe your fees,
Fixed (Other than Subscription)
$
Percentage of AUM
%
Hourly
$
Subscription Fees
$
Commissions
$
Performance-Based
$
Other (Please Specify):
12.
13.
States that you are registered in?
AL
DC
KS
MS
NY
RI
WA
AK
FL
KY
MO
NC
SC
WV
AZ
GA
LA
MT
ND
SD
WI
AR
HI
ME
NE
OH
TN
WY
CA
ID
MD
NV
OK
TX
CO
IL
MA
NH
OR
UT
CT
DE
IN
IA
MI
MN
NJ
NM
PA
PR
VT
VA
Are you interested in selling, merging, other? (Explain):
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CONFIDENTIAL CONTACT INFORMATION FOR PRINCIPAL DECISION MAKER
Name:
Confidential Phone:
Title:
Confidential Fax:
Confidential Email:
Other:
Note: This information is to provide a means of contact that will not leak your intentions to your organization
and will enable prompt communications during negotiations.
When completed, fax directly to Mark Harris at 678-815-1524 or email to [email protected].
Thank you.
IF YOU ARE A BD, WHAT INSTRUMENTS ARE YOU AUTHORIZED TO SELL?
Exchange member engaged in exchange commission business other than floor Activities.
EMC
Exchange member engaged in floor activities.
EMF
Broker or Dealer making inter-dealer markets in corporate securities over-the-counter.
IDM
Broker or Dealer retailing corporate equity securities over-the-counter.
BDR
Broker or Dealer selling corporate debt securities.
BDD
Underwriter or selling group participant (corporate securities other than mutual funds).
USG
Mutual fund underwriter or sponsor.
MFU
Mutual fund retailer.
MFR
U.S. government securities dealer.
GSD
U.S. government securities broker.
GSB
Municipal securities dealer.
MSD
Municipal securities broker.
MSB
Broker or dealer selling variable life or insurance or annuities.
VLA
Solicitor of time deposits in a financial institution.
SSL
Real estate syndicator.
RES
Broker or dealer oil and gas interests.
OGI
Put and call broker or dealer or option writer.
PCB
Broker or dealer selling securities of only one issuer or associate issuers (other than mutual funds)
BIA
Broker or dealer selling securities of non-profit organizations (e.g., churches, hospitals).
NPB
Investment advisory services.
IAD
Broker or dealer selling tax shelters or limited partnerships in primary distributions.
TAP
Broker or dealer selling tax shelters or limited partnerships in the secondary market.
TAS
Non-exchange member arranging for transactions in listed securities by exchange member.
NEX
Trading securities for own account.
TRA
Private Placement of securities.
PLA
Broker or dealer selling interests in mortgages or other receivables.
MRI
Broker or dealer involved in a networking, kiosk, or similar arrangement with a
1. Bank, saving banks or association or credit union
BNA
2. Insurance company or agency.
INA
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without the express written permission of BROKER DEALER MARKET, INC. BROKER DEALER MARKET, INC. is not a Broker Dealer, Attorney or Accountant.